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Maidawat nga pilyen iti pagilyan nu sadinoka nga agsansanay.
UnitedHealthcare Community Plan Rhode Island Providers

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Rhode Island providers.

Ditoy, masarakam ti impormasyon ken kamang a masapul mo tapno mangibanag ti negosyo iti UHC a Plano a Komunidad.  Choose your topic of interest by selecting one of the left navigation buttons.

Please choose your topic of interest, by selecting one of the navigation buttons on the left-hand side of the page, or select one of the topics or products below to view our Contact Information and Forms.

 

Medicaid Managed Care Rule External FAQs (PDF 64.57 KB)
Medicaid Managed Care Rule Presentation
(PDF 90.71 KB)

(PDF 59.89 KB)

Provider Call Center

877-842-3210
24 hours a day, 7 days a week and holidays

Postal Mailing Address

UnitedHealthcare Community Plan
475 Kilvert Street
Warwick, RI 02886
Maawagan ti imatang: Medicaid Program
 

Utlization Management Appeals Address   

UnitedHealthcare Community Plan
P.O. Box 31364
Salt Lake City, Utah 84131
 

Report Health Care Fraud, Waste and Abuse: 844-359-7736 or uhc.com/fraud

 

Provider Administrative Manual

Rhode Island Provider Manual (PDF 3.15 MB) 
1.22.2018: Manual currently under review, pending additional updates.

Quick Reference Guide for the UnitedHealthcare Administrative Guides (PDF 112.23 KB)

 

Prior Authorization

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 4/1/2018 (PDF 293.21 KB)

UnitedHealthcare Community Plan
UnitedHealthcare Community Plan Prior Authorization RI - Effective 4/1/2018 (PDF 237.67 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018 (PDF 282.37 KB)

 

UnitedHealthcare Community Plan Prior Authorization RI - Effective 1/1/2018  (PDF 238.86 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 KB)

UnitedHealthcare Community Plan Prior Authorization RI - Effective 10/1/2017 (PDF 243.32 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 7/1/2017 (PDF 300.09 KB)

UnitedHealthcare Community Plan Prior Authorization RI Effective 7/1/2017 (PDF 241.59 KB)

UnitedHealthcare Community Plan Prior Authorization RI - Effective 4/1/2017 (PDF 224.24 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 5/1/2017 (PDF 299.55 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 1/1/2017 (PDF 306.96 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 4/1/2017 (PDF 300.79 KB)

UnitedHealthcare Community Plan Prior Authorization RI - Effective 1/1/2017 (PDF 215.03 KB)

UnitedHealthcare Community Plan Prior Authorization RI - Effective 10/1/2016 (PDF 224.85 KB)

UnitedHealthcare Community Plan Prior Authorization RI - Effective 7/1/2016 (PDF 200.75 KB)

UnitedHealthcare Community Plan Prior Authorization RI - Effective 5/1/2016 (PDF 207.53 KB)

 

Medical Injectables

Dagiti medikasyon ti Espesyalidad nga parmasya ket masakop ti Medikal a Benepisyo mabalin nga maited ti agababali nga channels - home infusion nga pasilidad, outpatient nga pasilidad, wenno espesyalidad nga parmasya. 

Specialty pharmacy medications covered under the member’s medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

If you don’t want to buy and bill a specialty pharmacy medication covered under the member’s medical benefit, you may order it through the following network specialty pharmacy:

Ispesyalista a Parmasiya ti Network

Numero iti Telepono

BriovaRx

855-427-4682

The following specialty pharmacies also provide certain types of specialty medications:

Ispesyalista a Parmasiya ti Network

Kategorya ti Panagagas

Numero iti Telepono

Accredo (nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

Ispesyalista a Parmasiya ti CVS Caremark

Pulmonary Hypertension

800-237-2767


Coverage of a requested medication depends on the member’s benefit, and availability of a specific drug from a network specialty pharmacy may vary.

Upon request, a specialty pharmacy can deliver the medication to your office or another site such as a member’s home.

Medications obtained through a specialty pharmacy will be directly billed to the patient’s health plan.

 

UnitedHealthcare Community Plan Medical & Drug Policies and Coverage Determination Guidelines

UnitedHealthcare has developed Medical Policies, Medical Benefit Drug Policies and Coverage Determination Guidelines to assist us in administering health benefits. Dagitoy a pagalagadan ken pagannurotan ket maipaay para ti panangipakaammo a ranta, ken saan a mangbukel ti medikal a balakad.
View the guidelines

UnitedHealthcare Medicare Advantage Coverage Summaries

For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries Manual and corresponding policy update bulletins here

Integridad ti Claims, Reports, ken Panangibagi iti Gobyerno

UnitedHealth Grupo ket dawatenna ti panagtungpal kadagiti dawdawaten ti pederal ken paglintegan ti estado nga mangiparit ti panagsumite ti palso a claims a maikamang iti pederal a programa ti pannakasalwad ti salun-at, pakairamanan ti Medicare ken Medicaid. 
View our policy (PDF 38.15 KB).

Panangilibak

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. Tapno makita ti pakaaamo a panagbalbaliw ti pagalagadan, pilien ti Pagwarnakan a seksiyon iti kanigid.